This is a book about long-term trends in the health of Europeans, and about how and why diseases have come and gone. It is about the role of politics and biology, and about everything in-between, from religion to medical care and from tobacco control to the Industrial Revolution. Starting in the early 18th century and ending in the 2010s, it puts the spectacular changes in life expectancy and morbidity patterns into perspective, and tries to identify the deeper causes of the dramatic variations between European countries. Its main conclusion is that most diseases are man-made, that ‘human agency’ accounts for both the rise and fall of disease, and that between-country differences in political, sociocultural and economic conditions have profoundly influenced population health.
The idea for a book like this arose long ago, in 1984, when I read Fernand Braudel’s La Méditerranée – an integrated history of the whole Mediterranean area during the reign of Philip II of Spain (1527–1598) – while I was sitting under a cypress tree in the South of France. Full of admiration I thought by myself: how wonderful would it be to paint such a broad canvas on the history of health? It took more than three decades before I felt capable of giving it a try, and even now it is easy to see the enormous gulf between Braudel’s depth and breadth and my more modest achievement. Nevertheless, I hope readers with a similar interest in ‘big picture’ histories will be interested in the result.
While working on this book, I received generous support from many colleagues. After stepping down as head of the Department of Public Health of Erasmus MC in Rotterdam, I was allowed to spend the years remaining until my retirement on writing a book (I actually wrote two … the other one appeared in 2019 under the title Health inequalities: persistence and change in European welfare states). The Stichting Maatschappelijke Gezondheidszorg financially supported the production of this second and more ambitious book.
A special word of thanks goes to Marina Karanikolos (London) who helped me with collecting and analysing the mortality data. David Leon (London), Mart van Lieburg (Rotterdam), France Meslé (Paris) and Frans van Poppel (The Hague) read the manuscript and provided me with lots of detailed and useful comments. In various stages of writing, I also received useful suggestions from (in alphabetical order) Evgeny Andreev (Moscow), Virginia Berridge (London), Timo Bolt (Rotterdam), Francisco Bolumar (Madrid), Jan Willem Coebergh (Oegstgeest), Martin Gorsky (London), Martin McKee (London), Wilma Nusselder (Rotterdam), Şevket Pamuk (Istanbul), Diego Ramiro (Madrid), Enrique Regidor (Madrid), Paula Santana (Coimbra), Sergey Shishkin (Moscow),
Of course, all the remaining errors – and there are likely to be some, in view of the vast terrain I had to cover – are entirely mine.
Rotterdam, December 2019
Johan Mackenbach